6655 SW HAMPTON STREET STE 210 u�
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6655 :;W HAMPTON SUITE 210
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r--mmunity Development ELECTRICAL PERMI i APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
4 Permit #
Phone (503) 639-4171 Date Issued to /S- -76
FAX (503) 684-72.97 Issued by .c X",�P
CITY OF TIGARD TD n- No. (503) 634-2772
Inspection (503) 639-4175
1. Job Address: W 14. Complete Fee Schedule ee/ow:
Name of Development_H a m p t o n 0 a k S — Number of Inspections pet permit allowed —
Service included Items Cost(ea) Sum
Address 6655 S .W . Hampton Suite,uite 210
City/State/Zip P.o l:':0-a-nd t OR 97223___ 4s. Residential-per unit
1000 sq It or loan $11000
Name (or name of business)
C u r r a l l-McLeod Esnh additional 500 sq It or
_.. portion thereof __V $25 00
^ Limited Energy $?5 00
Commercial lel Residential ❑ :a&Maoul'd Home at Modular
(hvelhng Service or Fonder won —
29. Contractor installation only: 4b.Services or Feeders
Inatallcaon,altaration,or relocation 2
Electrical Contractor E l e c t r i c a l C o n t r ' s Desi - n 200 amps or less __ $60 00 — 2
Address_15 O N E 1t i c t o r v S u l e "A.r 201 amps to 400 amps $8000 2
401 amps la 600 amps $12000 2
City Gres h a m State_QR_, Zip 9 7 0 3 0 rot amps to 1000 amps $18000 z
Phone No. LLL-_9Lrf; Over neL1 amps or vain $$4o 0o
ReconneU only $5000
Contractor's license No. 2 6-4 6 6 C
Contractor's Board Reg. No.__ 4 7 712 4c. remporery Services or Feeders
Irstallahon aneration,or relocation
Signature of Supr. Elec'n1�� — 200 amps or leas f50 00
201 amps to 400 amps $7500
License No, 18 8 2 S --_ Phone No6 6 ;-9358 -- 401 amps to 900 amps $1on no
Over Win amps to 1000 Vona
2b. For owner installations. sea-t,Ahmn
4d. Branch Circuits
Print Owner's Name New alteration or extension per panel
Address `�� a)The fop for branch circuits with
purchase of evvka or feeder to*. 2
City StateZlpEach branch orcurl $5 o0
Phone No. __ b)The foe for branch circuits without 2
The installation is being made on property I own which is purchase of ssrvks or kedsr W.
First branch circuit _ 2
not intended for sale, lease or rent. Each additional branch circuit _ x500
Owner's Signature--_��__�_ __ __ � 4e. Minceflaneous —
(Sfrrvlce or feeder not included)
?. Plan Review section (if required). Each pump m irrigation circle $40 U0
Farb sign or outline lighting ti40 UO
Signal circuit(s)or a limited energy
Ploase check appropriate Item and enter fee in section 5B. panel aneralion or extension $4000
_ 4 of more residential units in one structure Minor Lnhols(10) __` $10000
Service and leader 225 amps or more
41. Foch additional inspection over
System over 600 volts nominal
Classified area or structure containing special occupancy the allrwable in any of the above
.. G'er inr,p—in�i __ $3500
as described in N E C Chaptar 5 Per ho... $5500
In Plant $5500 --
Submit
—Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services. 5. Fees:
Ss. Enter total of above fees $ 65 . 00
NOTICE 5%Surcharge(.05 X total lees)
PERMITS BECOME VOICt IF WORK OR CONSTRUCTION Subtotal $ �.-�-5
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF 5b. Entet 25%of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Platt Review if required(Sec 3) $ _
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
Subtotal $
COMMENCED ❑ Trust Account M $
Balance Due $ 68 . 25
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CITY OF TIGAAD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service FINAL:
Foundation Water Une Ceiling -Plumb.
Post/Beam Mech. Shear/Sheaih Framing -Mech.
Plbg.Und/Flr/Slab Pibg. Top Out Insulation lec
Post/Beam Struct. Mech. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other: ---
Date: -�'-'-'-t�" A.M. P.M. Entry;
Address:
Tenant: Ste: U MST:
r �C BUP:
Con/Own: \,i-A .-�J (C 0 3 y_7 Qq MEC:
ELC: 511
THE FOLLOWING CORRECTIONc.,4 PEOUIRE'D: ELR:
t<J - �..
Inspector: r �F Date:
APPROVED —DISAPPROVED/CALL FOR REINSP. !CFCO